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11/16/2013

So you don't get to keep your doctor?: Now thousands of doctors are being dropped from insurance plans

Remember the promise about being able to keep your doctor? Did you want to keep your doctor? Well, they were probably subpar too, right? Obama is just protecting you from those subpar doctors. From Reuters:

The insurer said in October that underfunding of Medicare Advantage plans for the elderly could not be fully offset by the company's other healthcare business. The company also reported spending more healthcare premiums on medical claims in the third quarter, due mainly to government cuts to payments for Medicare Advantage services. . . .

The insurer told the WSJ that its provider networks were always changing and that it expected its Medicare Advantage network to be 85 percent to 90 percent of its current size by the end of 2014. . . .

The proposal was rushed out on Thursday for two purposes: to give Congressional Democrats cover today before a vote in the House and shift the blame to others. As will be explained shortly, Obama ignored that there is no way for insurance companies to ignore the current law as it stands.

Five million Americans have so far lost their insurance and they are suffering sticker shock from the new policies. More Americans on individual plans will soon get notices.

Unfortunately, the problem won’t be limited to the five percent of Americans that Obama claimed on Thursday. Over the next year, at least a total of 129 million Americans will find that they can't keep their current policies as employer-based insurance policies face renewal.

Obama's "solution" to people losing their policies is to promise he will not enforce part of the ObamaCare law for one year. . . .

UPDATE: Democrats are now planning on attacking insurance companies for not providing the old insurance plans. From The Hill newspaper:

They say the ball is now in the industry’s court after the president announced his administration would let companies continue to offer plans that do not meet the law’s standards if people want to keep them.

“What we have to do is have all legislators team up and call upon the insurance industry to honor their side of the bargain because it requires not only the government side but it requires the insurance companies to keep offering the policies and not cancel them on folks,” said Sen. Jeff Merkley (D-Ore.).

“I’ll be calling on insurance companies to continue to extend the individual plans that citizens currently have,” he said.

A senior Senate Democratic aide said companies should take advantage of the one-year administrative fix Obama announced Thursday.

“This now rests at the feet of the insurance companies. They’re the ones that have to step up and make the plans available,” the aide said.

UPDATE: Here is a statement from a Democratic congressman wondering whether Obama has the legal authority to do what he did.

Germany thus embarked on an experiment in liberalisation just as Sweden, a country culturally similar in many ways, was going in the opposite direction. In 1999 the Swedes had made it criminal to pay for sex (pimping was already a crime). By stigmatising not the prostitutes but the men who paid them, even putting them in jail, the Swedes hoped to come close to eliminating prostitution. . . .

Prostitution seems to have declined in Sweden (unless it has merely gone deep underground), whereas Germany has turned into a giant brothel and even a destination for European sex tourism. The best guess is that Germany has about 400,000 prostitutes catering to 1m men a day. Mocking the spirit of the 2001 law, exactly 44 of them, including four men, have registered for welfare benefits. . . .

This provides an interesting opportunity to test to see if making it easier or harder for prostitution impacts rape rates. I have only spent a short amount of time on putting some data together, but the results depend on how crime is measured. If it is measured in terms of crimes reported to police, crimes are falling in Germany after their change and rising in Sweden (though the data that I have is only available after 2003).

Regarding the Survey data, the results are much less clear, but seem to suggest no difference. Obviously this is only very suggestive and very incomplete since the data for Germany leaves a large gap between 1985-1989 and the 2001 to 2005 period. In addition, nothing else has been controlled for in examining these numbers.

The Economist had this interesting explanation for why the two countries made such different decisions.

Both the Swedish and the German laws originated in the feminist and left-leaning movements in these countries. But whereas progressive Swedes view their state as able to set positive goals, Germans (the Greens, especially) mistrust the state on questions of personal morality as a hypocritical and authoritarian threat to self-expression. . . .

11/15/2013

Evidence that the changes in part-time jobs over this year have been related to the employer health insurance mandate

If you graph out the data on the change in part-time jobs and take into account that the Obama administration announced a temporary delay in the employer mandate in early July, it sure looks like part-time jobs were increasing for a few months as employers thought that they were getting closer to the mandate going into effect and that as soon as the mandate was put on hold there was a sudden drop in part-time jobs. The reason that others are missing this pattern is that they aren't taking into account the Obama administration announcement and the fact that there is no reason to push people into part-time employment a long period of time before the rule finally goes into place.Note that there were no similar sudden swings in full-time jobs over the same period of time.

With the one year delay, the number of part-time jobs seems to have gotten back to its original trend. If I am right, we will again see an increase in part-time jobs next year. Obviously these changes are small, but it appears that this small variation could be related to Obamacare.The data from the BLS.gov is available here.

Obama's big lie about the number of people who have signed up for Obamacare

The Obama administration's report on the number of people who have signed up for Obamacare is available here. If you read the report you will continually see this phrase: "including both those who have paid the first month’s premium and those who have not yet paid the first month’s premium." This is the equivalent of Amazon.com counting people putting an item in their online basket as a sale. If Amazon.com told its shareholders that it had made these "sales," the Obama administration would sue them for fraud.The irony is that when the Obama administration compares the current sign up rate to past efforts under previous administrations, they count enrollment the way they should be counted. So for example on page 24 when the report discusses enrollment for Medicare Part D they note: "This data (and graph) includes only those who affirmatively enrolled and paid a premium for a standalone Medicare Part D plan."

So much for Obamacare controlling insurance premiums

Note this graph doesn't yet include the big changes that will take place on January 1st. But what we are already seeing I think qualifies as another promise broken by President Obama. During his press conference yesterday, President Obama again attacked insurance companies, blaming them for any future problems with Obamacare.

11/14/2013

Reading the New Republic for its entertainment value because one apparently can't expect them to be too accurate

I guess that I have a hard time understanding why anyone would read the New Republic for anything other than entertainment. Here is their discussion on my interactions with Piers Morgan:

Morgan’s current determination is hard to deny. His effectiveness is less clear. For one thing, there’s the way he handles guests. Morgan tends to let hotheads like Jones rant unchecked (ostensibly to expose their insanity, though after a point, he is just giving them a bigger platform). But then he steamrolls authors and academics whose logic is actually worth debunking. Take economist and gun-rights proponent John Lott, whose head Morgan permitted to occupy one side of a split-screen while he talked over him for ten minutes. Lott, author of the book More Guns, Less Crime, attempted feebly to interject, but Morgan wasn’t having it. “I am going to keep talking, so I suggest you keep quiet,” the host informed the guest. To which Lott replied, shoulders slumping: “I don’t see what the point of having anybody on is if you’re going to talk for ninety percent of the time.” And still Morgan barreled on. . . .

The quote from me was made at 10:59 into this video. As far as I tell my shoulders didn't slump and I didn't stop responding, but I suppose that it the New Republic's attempt at trying to prove that I somehow felt defeated. In addition, I would like to believe that at least viewers learned that gun bans caused murder rates to rise and that Piers was very selective in the data that he picked.

This might be different if the regulatory system let insurance companies do what they want, but that is hardly the case. However, what I would say is that a lot of employer plans are going to be cancelled over the course of the coming year and those cancelations can still be fixed.

11/13/2013

Fox News Poll: By a 55 to 38 percent margin Americans think that Obama "tried to deceive" them about Obamacare

The recent Quinnipiac Poll showed that Americans believe Obama isn't honest by a 52 to 44 percent margin, but surprisingly they don't think that Obama knowingly deceived them on keeping their insurance plans. A new Fox News poll has some different results: a 59-percent majority believes the administration knew ahead of time that people would be kicked off their insurance because of the law, and 55 percent think the White House has “tried to deceive” people about it. Some 38 percent say the administration has “been honest.” According to the poll Obama's approval rating has gone down to 40 percent.

Independents believe that Obama has tried to deceive Americans about the Obamacare by a 51 to 34 percent margin. One bizarre note is that those with a college degree don't feel that Obama has been deceptive as much as those without a degree. Younger people and higher income people also thought that Obama was "knowingly lied" to people. Click to make larger.

Shocking how the government uses taxpayer funds to buy support from private entities

Given how much money the government has access to, they could buy support for Obamacare from almost anyone. For an administration claims to have high standards of transparency, it is astounding that the Obama administration wouldn't make clearly public that they are making these bribes. From the Washington Times:

The consumer health care site had the occasional nice thing to say about Obamacare, too. In one article, it predicted doctors might pick up more patients and crowed in an article titled “7 Surprising Things About the Affordable Care Act” that many consumers already had received insurance refunds under the law.

But what neither Health and Human Services Secretary Kathleen Sebelius nor WebMD mentioned at the time was that the company, which millions of Americans regularly read for health news, also stood to earn millions of dollars from a federal contract to teach doctors about Obamacare.

It is true that only two universities were examined, but most of the rest of the statements are misleading or wrong.

1) While both schools tended to have relatively low total African-American enrollment, the point of the study was to examine how students did as they went from one class to another. In some of their classes there were few black students, but in others they made up fairly high percentages of the students in those classes. So it wasn't that the schools lacked data to study critical mass. There is a very large range of percentage of black students in these classes.

2) It is simply false to claim "their model do not incorporate other potential explanatory variables that could affect grades, such as the imposition of a mandatory grade curve or the skills tested on examinations." The estimates accounted for fixed effects for student, class, professor and semester. Those fixed effects will pick up all the differences across how different teachers teach and across different classes. The paper also explains out the grade curve issue biases the results against the results that we found.

3) Neither the brief of Scholars of Economics and Statistics nor the paper with Ramseyer or Standen "neglect" or hide the one result for Asian Americans that there is a benefit to Asians from more Asians. In the brief it is noted: "Only for Asians was there evidence that increasing their share of the class after they exceed their share of the applicant pool increased their grades, but the effect was exceedingly small."

4) There is no other evidence that directly tests the critical mass claim. If one believes the American Educational Research Association Amicus brief, they don't even appear to think that the "critical mass hypothesis" is testable because they don't even think that there is an identifiable "critical mass."

Spike Lee sued for tweeting the wrong address in trying to get people to attack George Zimmerman

What was Spike Lee's intent when he tweeted: “I don’t give a f— what you think kill that Bitch. HERE GO HIS ADDRESS, LET THE HUNGER GAMES BEGIN”? Encouraging violence against anyone, particularly a completely innocent party is very scary. From Variety:

Spike Lee
has been sued by an elderly couple in Florida, whose address he
incorrectly identified as the home of Trayvon Martin killer George
Zimmerman, according to court documents obtained by the Smoking Gun.

The suit claims the “Do the Right Thing” director tweeted out the
Florida address along with George Zimmerman’s name in March 2012 to his
240,000-plus Twitter followers.

“While defendant intended to post the home address of George
Zimmerman, he actually posted the address of plaintiffs Elaine McClain
and David McClain,” the complaint reads.

Several Democratic senators, led by Judiciary Chairman Patrick J. Leahy of Vermont, met with reporters late Tuesday with another round of warnings about the chances that not filling the seats on the appellate court could lead to a “nuclear option” rules debate.

“I’ve said it before and I’ll say it again. There comes a tipping point, and I’m afraid we’ve reached that tipping point,” Majority Whip Richard J. Durbin of Illinois said at the news conference. “We cannot ask people in good faith to submit their names and reputations to this judicial process if they’re going to be treated so unfairly and unjustly by the Republicans and their filibusters.” . . .

For the first time, Reid has the strong backing of Senate Judiciary Committee Chairman Patrick Leahy (D-Vt.), who had been leery about weakening the power to filibuster judicial nominees.

“I’m glad that I’m not the only one out talking about this,” Reid said last week when asked about the possibility of rules reform. “We have someone who [has] never, ever been upfront on rules changes — that’s Sen. Leahy, who said he’s really disturbed about what’s going on.”

Leahy’s support might help Reid persuade wavering colleagues to strip Republicans of the power to filibuster judicial picks.

“He has the backing of Sen. Leahy, which is huge for this. That’s a really important step,” said a Senate Democratic aide.

Reid came close to triggering the so-called nuclear option in July after Republicans held up Obama’s picks to executive branch agencies such as the Consumer Financial Protection Bureau, the Environmental Protection Agency and the National Labor Relations Board. He backed off the threat after Republicans allowed the nominees to go through. . . . .

Reid came close to triggering the so-called nuclear option in July . . .

Such a move would prompt howls of outrage from Republicans and could have dramatic implications for the future of the Senate. But it would allow Senate Democrats to pass a bill raising the borrowing limit through 2014 and shift the burden to the House GOP before a potentially devastating default on the $16.7 trillion national debt on Oct. 17. . . .

Strangely, it isn't clear what the benefit is for Democrats to change this given that the Republicans control the House. UPDATE: The National Journal indicates that it looks as if the Democrats now have the votes to push through the "nuclear option."

Can the New York Times survive? Top talent jumping ship

In the last nine months, at least a dozen top reporters and editors have made for the exits. Among them are such well-known and respected journalists as: Nate Silver, who sprinted to ESPN; David Pogue, who decamped to Yahoo News; Jeff Zeleny, who left for ABC News; and Rick Berke, who is en route to POLITICO. That’s not counting the many editors and reporters who took buyouts at the beginning of the year.

On Tuesday, in a sucker-punch to staff morale, the Grey Lady lost three more: Brian Stelter, the paper’s marquee media reporter, announced he would go to CNN; Matt Bai, the Times Magazine’s chief political correspondent, decamped to Yahoo; and Capital New York reported on Monday night that Hugo Lindgren, the editor of the Times Magazine, will leave at the end of the year.

The departures have brought the Times face-to-face with a harsh reality: In the new media landscape, some journalists have become their own brands with followings and reputations that are not dependent on the ‘aura’ of the paper of record. Some built their brands at the paper, but it does not necessarily have the resources or flexibility to keep them. Meanwhile, deep-pocketed competitors are willing to pay top dollar for top-flight talent — an issue not only the Times but many large media outlets are facing. . . .

The newspaper’s latest financial results show that this is still the case: although the Times has seen further growth in subscriptions, its overall revenue barely budged, and much of that lack of movement was due to continued declines in the paper’s advertising revenue — both in the print version and online. . . .

American voters say 52 – 44 percent that Obama is not honest and trustworthy, but they don't think that Obama knowingly deceived them on keeping their insurance plans

For the first time, the Quinnipiac Poll finds that most Americans don't view Obama as honest. The surprising thing to me is that most people view Obama as dishonest, but they don't believe him as being deceptive about whether people could keep their health insurance if they are happy with it. I don't understand why most people don't believe that Obama was deceiving them on keeping their insurance. For example, House Democratic Whip Steny Hoyer has acknowledged:

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

Yet President Obama, who had promised in 2009, "if you like your health plan, you will be able to keep your health plan," was still saying in 2012, "If [you] already have health insurance, you will keep your health insurance.". . .

Megan Kelly has a very powerful discussion available here.So is it only that Americans haven't followed the evidence here? From Quinnipiac University Poll (November 12, 2013):

Only 19 percent of American voters say the quality of care they and their families receive will improve in the next year because of the Affordable Care Act (ACA), while 43 percent say it will get worse and 33 percent say ACA won’t affect their health care.

The rejected Ultrasound Act stipulated that at least one hour before an abortion physicians must 1). perform an ultrasound 2). explain what it depicts 3). show the pregnant woman 4). provide a medical description “which shall include the dimensions of the embryo or fetus, the presence of cardiac activity...the presence of external members and internal organs….”

States with functioning exchanges have signed up 49,100 people compared with the 1.4 million people expected to be enrolled for 2014, according to the report by healthcare research and consultancy firm Avalere Health.

With enrollment in the federal HealthCare.gov website serving 36 states stalled by technical failures, the weak sign-ups for functioning insurance exchanges could be due to the administration's difficulty to promote the program as a success, Avalere said.

The government is due to release national enrollment figures for the month of October this week. Open enrollment ends March 31, 2014. . . .

Avalere looked at 11 of the 14 states and Washington D.C. that elected to build their own exchanges for individual insurance. . . .

Gonzaga students who used gun to defend themselves will not be expelled, will be put on permanent probation

This is one school that I would appreciate the chance to debate at, especially given that they are reconsidering their policies on guns on campus. Despite the pressure put on them, the student with the gun still said that he was glad that he had it and would rather be expelled than not have had the gun to protect himself. From KREM.com in Spokane, Washington:

"As a Jesuit institution dedicated to thoughtful evaluation of complex social issues," Gonzaga will use the incident to re-examine its policy, President Thayne McCulloh said in a weekend statement. . . .

Gonzaga should consider student safety above all else, said their lawyer, Dean Chuang.

"We're glad that it didn't have to end in tragedy for them to consider changing the policy there," Chuang said. "Our boys were armed and stopped a home invasion here." . . .

UPDATE: If a robber wants to rob people, where should he go? You might think that a University would be an attractive target, right?

Two seniors from Gonzaga University in Spokane face expulsion over using a gun to defend themselves against a six time felon

The reporter here asks a great question: How are students supposed to defend themselves in the worst case scenario when someone enters the apartment? The university's response ignores the obvious. The statement that there is security all over campus and that students are supposed to keep their doors locked isn't an answer. There was no campus security officer present. Clearly security isn't all over campus. These students very likely wouldn't have had time (or the ability) to make a call, let alone wait for the security to arrive. Great advice on locking the door, but what if the criminal does get in or surprises the students as happened in this case? The engineering student comment is powerful that he has no regret and would do everything all over again because he would rather risk expulsion than lose his life.More on the story is available here. Thanks to Tony Troglio for the link.

Is gun ownership declining?: Yet more evidence that it is increasing

The General Social Survey is taken as evidence that despite gun sales soaring, the percent of the population owning guns has fallen. As I have noted previously, this claim is inconsistent with other surveys and it is also inconsistent with the huge increase in the number of concealed handgun permits. Well, it turns out that this is also inconsistent with the issuance of FOID cards in Illinois.

The real number isn’t that high — just 49,000, according to state police. But those numbers belie a bigger headache awaiting the state’s bureaucracy now that lawmakers have set in motion a process to facilitate the carrying of concealed weapons in public, as mandated by a federal court order.

Whereas a few years ago, 1.2 million Illinoisans held Firearm Owners Identification cards, the number has jumped to 1.6 million, state police spokeswoman Monique Bond said. Soon after the court decreed in December that Illinois couldn’t ban public carry anymore, demand for FOID cards jumped precipitously. In January alone, Bond reported, there were 61,000 FOID applications, nearly double the 31,000 in January 2012. . . .

Some data on state sign ups for Obamacare, things look bad even though they are excluding the worst numbers

The figure represents about one-tenth of an initial enrollment target from the Obama administration that has been cited by Republican lawmakers.

The report by the Wall Street Journal, citing two people familiar with the matter, comes as federal health officials prepare to release official sign-up figures from healthcare.gov for the first time later this week. . . .

Original Post: Presumably these numbers will increase dramatically in the near future. But what really concerns me is the number of people who, despite Obama's frequent promise, have lost their insurance policies. You throw off enough people from health insurance and you will force them to go through the Obamacare website because that is the only game left in town for health insurance. Note that these numbers for lost policies only include those who had an individual plan those who are losing their employer based insurance are strangely excluded by how the Obama administration counts these things. If the numbers were counted correctly, they would be staggering.
North Dakota

Lafayette, LA: Armed family members rescue woman who had been kidnaped, fatally shoot kidnapper

Police saidthat family members searched an abandoned property in Duson, La., and saw Arceneaux inside. When they confronted her kidnapper, 29-year-old Scott Thomas, he reportedly started attacking the woman, and he was shot by one of the woman's relatives. From KLFY in Louisiana:

[W]e are getting good news from Bethany Arceneaux's family. They tell KLFY she was hurt, stabbed and cut, but is expected to recover. They want to let Acadiana know she's been found and thank the community for the help. . .

I guess that we will soon find out whether the relative had a concealed handgun permit because if he didn't police will have to press charges against him.More on the dramatic events is available here from the UK Daily Mail:

'We kicked doors down. It was like a movie unfolding,' Miss Arceneaux's brother, Ryan, told the Advertiser. 'If we would have waited, she would have been dead.'Ryan was part of a search party made up of family and friends who were helping police try to find Miss Arceneaux after Thomas, the father of her two-year-old son, grabbed her on Wednesday evening. . . . Kaylyn Alfred, another of the victim's brothers, said they heard screams for help as they entered the desolate building. As the search party confronted Thomas, who was the subject of a restraining order, he allegedly began to harm Miss Arceneaux.In the tussle that followed Thomas was shot and Marcus Arceneaux was able to grab his niece and carry her to safety. 'She’s shook up, she’s sliced up, but she’s alright, Ryan said. His sister was believed to have been stabbed but is recovering in hospital and has been reunited with her son. Captain Kip Justice of the Lafayette Parish Police Department confirmed that 29-year-old Thomas died as a result of injuries received in the confrontation. . . .

Apparently, Bethany Arceneaux had a protective order against her ex-boyfriend and he had already violated the order at least once, but it obviously didn't do her much good. From USA Today:

My recent testimony to the US Senate was quoted by Rep. Matt Gaetz during the Stand Your Ground debate in Florida. He began quoting from John Lott's testimony at about 3:31 into this video and continues until 4:31. His entire testimony is worth listening to and quite powerful.

Mental health professionals have sought this change for decades, both to improve treatment and to lift a long-standing stigma. Friday's announcement means insurance companies now must provide the same benefit coverage for illnesses of the mind they have long provided for every other kind of illness. . . .

"Imagine what it would mean if people felt as comfortable saying they were going for counseling as they do saying they're going for a flu shot or physical therapy," Sebelius said. . . .

They point to mental illness and these mass shootings, but they fail to show two things. 1) Did these killers try to get mental health help and fail? 2) Are they really mentally ill? The first point is pretty critical, but I have seen no evidence that is the case. The administration hasn't provided any evidence. On the second point, here is something from the WSJ:

Instead, massacre killers are typically marked by what are considered personality disorders: grandiosity, resentment, self-righteousness, a sense of entitlement. They become, says Dr. Knoll, " 'collectors of injustice' who nurture their wounded narcissism." To preserve their egos, they exaggerate past humiliations and externalize their anger, blaming others for their frustrations. They develop violent fantasies of heroic revenge against an uncaring world. . . .

There has also been a CBS radio news report that I heard that this spreadsheet contained counts of media coverage. CBS News notes how Lanza was in competition with the Norway killer for the amount of attention that he received:

Sources say Lanza saw himself as being in direct competition with Anders Breivik, a Norwegian man who killed 77 people in July 2011. . . .

Two officials who have been briefed on the Newtown, Conn., investigation say Lanza wanted to top Breivik's death toll and targeted nearby Sandy Hook Elementary School because it was the "easiest target" with the "largest cluster of people." . . .

Also, I suspect that Lanza chose an elementary school so he could - in his mind - "score the most points" by claiming the most victims and also get victims who would generate the most sympathy. Other killers have also compared themselves to those in past attacks and hoped to beat their numbers. From the WSJ:

Never publish a shooter's propaganda. Aside from the act itself, there is no greater aim for the mass killer than to see his own grievances broadcast far and wide. Many shooters directly cite the words of prior killers as inspiration. In 2007, the forensic psychiatrist Michael Welner told "Good Morning America" that the Virginia Tech shooter's self-photos and videotaped ramblings were a "PR tape" that was a "social catastrophe" for NBC News to have aired.

Hide their names and faces. With the possible exception of an at-large shooter, concealing their identities will remove much of the motivation for infamy.

Don't report on biography or speculate on motive. While most shooters have had difficult life events, they were rarely severe, and perpetrators are adept at grossly magnifying injustices they have suffered. Even talking about motive may encourage the perception that these acts can be justified.

Police and the media also can contain the contagion of mass shootings by withholding or embargoing details:

Minimize specifics and gory details. Shooters are motivated by infamy for their actions as much as by infamy for themselves. Details of the event also help other troubled minds turn abstract frustrations into concrete fantasies. There should be no play-by-play and no descriptions of the shooter's clothes, words, mannerisms or weaponry.

No photos or videos of the event. Images, like the security camera photos of the armed Columbine shooters, can become iconic and even go viral. Just this year, the FBI foolishly released images of the Navy Yard shooter in action.

Finally, journalists and public figures must remove the dark aura of mystery shrouding mass killings and create a new script about them.

Talk about the victims but minimize images of grieving families. Reports should shift attention away from the shooters without magnifying the horrified reactions that perpetrators hope to achieve.

Decrease the saturation. Return the smaller shootings to the realm of local coverage and decrease the amount of reporting on the rest. Unsettling as it sounds, treating these acts as more ordinary crimes could actually make them less ordinary.

Tell a different story. There is a damping effect on suicide from reports about people who considered it but found help instead. Some enterprising reporters might find similar stories to tell about would-be mass shooters who reconsidered.

Rampage shootings are fed by many other sources that also must be addressed, of course. Many shooters have suffered bullying, which inflicts a sense of powerlessness that their actions aim to overcome. Some (though not most) shooters have had prior contact with mental health services, and many give recognizable warnings beforehand to friends, family or teachers. Institutionally and individually, we must learn to take these signs seriously and report them to authorities. Massacres also would not be nearly so lethal without the widespread availability of guns and high-capacity magazines designed more for offense than for defense.

But, guns aside, these factors are more or less perennial problems of human life and cannot, alone, bear the blame for rampage shootings. In coverage of these events, the focus on insanity particularly risks playing into the need of potential future shooters to convince themselves that the world rejects them, rather than the other way around. The minority who really are psychotic, or just act impulsively, are even more likely to draw their ideas from the cultural ether. . . .